SELF EMPLOYED CREDIT CARD APPLICATION FORM

1 Organisat on Details

Organisat on Name

Please ind cate your

Account Number

2 Cardholder Information

Client Name (Surname)

First Name /Middle Name

(Surname, First name and Other name(s) should be the same and follow the same arrangement provided at account opening)

Bank Verif cation Number (BVN) Please ind cate your

Account Number
Country Code Phone No.

Mobile Phone No.

Personal E-mail Address

Mother’s Maiden Name

Type of Residence Self Owned Rented Company Owned Length of stay at current address

Income Receipt Date D D

Employer’s Name

Employer’s Address

Current Resident al Address

Flat/Build ng Number

Street Name

City / LGA

State / Country

Nearest Landmark / Bus Stop

3 Card Variant And Payment Option

Card Types Visa Gold Visa Platinum Visa Infin te

Repayment Option ✔ Min mum Amount Due Lim t Required (NGN)

Name as it should appear Debit my account

on your Credit Card
Credit card Repayment Mode: ✔ on the due date
(maximum of 19 characters)

4 Card Delivery

Please be informed that your Credit Card will be delivered to your registered mail ng address.
SELF EMPLOYED CREDIT CARD APPLICATION FORM: Vs OCT 2023

In case of unsuccessful delivery, we will send your card(s) to the branch nearest to your Mail ng Address. We will not deliver to overseas address and P.O. Box.
Where mail ng address is P.O. Box, we will mail to the registered resident al address.

5 Declaration

By sign ng these general terms:

1. You agree that we can send all correspondence in electronic form using email or any other electronic media. However, we reserve the right to send paper correspondence to your last known address as per our
records and you consent for the Bank to accept informat on from your designated email address for any speci c informat on (includ ng your acceptance of the Lending Product) that we may need to process this
applicat on. You also indemn fy the Bank against all losses, claims, actions, proceedings, demands, damages, costs, and expenses incurred, or in connection with any such acceptance, except as may arise by
reason of the gross negligence or willful default of the Bank. You acknowledge your approval and acceptance for any losses, which may be sustained by you as a result of the risks to which the said electronic
transmiss on may be subjected.
2. You represent and warrant that all informat on (includ ng any document) you have given us in connection with this applicat on includ ng minor accounts, if applicable, is correct, complete and not mislead ng. If
this is not the case, you may be personally liable. You must notify us if you become aware that any informat on you have given changes, is incorrect or mislead ng.
3. You represent and warrant that you have power and all necessary authorizat ons to own your assets and carry on any business you conduct, to enter into each of our banking agreements and any other
arrangements with us and to comply with your obligat ons and exercise your rights under them.

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 4. You agree that Standard Chartered Bank may request your account statement from other banks via the My Bank Statement applicat on for risk assessment and underwrit ng of your loan, and you have provided
the bank’s name, your account number and your registered phone number with the other bank for this purpose.
5. You are aware that generating your account statement will attract a charge from your other bank and you hereby authorise Standard Chartered Bank to make the relevant payment from funds you have provided
in advance to cover this cost.
6. You consent to each of Standard Chartered Bank Niger a Lim ted and its subsid aries for investment products and affil ates (includ ng each branch or representative office) (“Standard Chartered Group”), its
officers, employees, agents and advisers disclos ng informat on relating to you (includ ng details of our banking agreement, the accounts, the products or any arrangement with us) to our head once and any
other member of the Standard Chartered Group in any jur sdict on (”permitted parties”); professional advisers, service providers (whether located in Niger a or outside) for the purposes of provid ng any service to
you in connection with this applicat on or an applicat on for Investment Services (includ ng data processing), or independent contractors to, or agents of, the permitted parties, such as debt collection agencies
data processing firms and correspondents who are under a duty of confident ality to the permitted parties, any actual or potential partic pant or sub-partic pants in relation to any of our obligat ons under our
banking agreement between us, or assignees, novate or transferee (or any officer, employee, agent or adviser of any of them), any credit reference agency, rating agency, business alliance partner, insurer or
insurance broker of, or direct or ind rect provider of credit protection to, or any permitted parties; any court, tribunal or authority (includ ng an authority invest gating an offence) with jur sdict on over the
permitted parties; a merchant or member of VISA International or MasterCard International where the disclosure is in connection with the use of a card, any authorized person or any security provider; any one we
consider necessary in order to provide you with the services in connection with an account.
7. You have read and understood or have been explained to (in the language you understand), our Personal Loan Terms and Credit Card terms - https://av.sc.com/ng/content/docs/ng-cc-terms-condit ons.pdf
and privacy statement - https://www.sc.com/ng/privacy-notice/ which forms our banking agreement. They are available on our website at www.sc.com/ng or call us on +234 1 270 4611-4 or our toll free number
08001235000 for a physical copy. You agree to be bound by them when using any product that we may provide you with.
8. You undertake to notify the bank with n (30) calendar days if there is a change in any informat on which you have provided to the bank and you consent to the Bank using exist ng informat on available in the bank
records to pre-qualify you for bank's products.
9. You acknowledge that you are bound by any variat on we make to these documents, in accordance with our banking agreement. In particular, you understand that by entering into our banking agreement, you
give indemn ties, authorizat ons, consents and waivers and agree to lim tations on our liab lity. Please click on the link to access the banking terms, product features and the tariff guide -
http://www.sc.com/global/av/ng-tarrif-guide-new.pdf
10. You agree that non-payment of monthly dues will translate into blocking of your account/ card with us, negatively impact your credit rating and may affect your access to future loans from any reputable lending
inst tution.
11. You covenant that by sign ng this term, offer letter, and by drawing on the loan, to repay the loan as and when due. In the event that you fail to repay the loan as agreed, and the loan becomes delinquent, the bank
shall have the right to report the delinquent loan to the CBN through the Credit Risk Management System (CRMS) or by any other means, and request the CBN exercise its regulatory power to direct all banks and
other financ al inst tutions under its regulatory purview to set-off my indebtedness from any money standing to my credit in any bank account and from any other financ al assets they may be holding for my
benefit.
12. You agree that Standard Chartered Bank may obtain and use your credit reports from Credit Bureau Agencies for underwrit ng of your loan as required by law and that we may share your credit data with our
affil ates, agents, regulatory bodies or anyone permitted by law.
13. You agree that if your loan is approved, the cost of the credit bureau reports should be deducted from the loan management/facil ty enhancement fee. If the loan is not approved, you agree that your account
should be debited for the cost of the credit bureau reports.
14. You hereby waive any right of confident ality whether aris ng under common law or statute or in any other manner whatsoever and irrevocably agree that you shall not argue to the contrary before any court of
law, tribunal, admin strative authority or any other body acting in any jud cial or quasi-jud cial capacity.
15. You agree that we can disclose share your credit data with Credit Bureau Agencies or other Regulators or anyone allow by law and obtain your credit bureau reports before underwrit ng your loan as required by
law, and should your loan be approved, the cost of the bureau reports should be deducted from the loan Management/Facil ty Enhancement Fee. Where the loan is not approved, you agree that your account
should be debited for the cost of credit report directly.
16. You confirm that you have been provided with all the informat on on the product and have been given suffic ent time to consider the suitab lity of the product before sign ng up.
17. You certify that all the informat on provided on the applicat on form above is true, correct, and complete and hereby authorise the Bank to make all enquir es considered necessary and proper for the purpose of
evaluating this applicat on. The credit reference and fraud prevention agencies may use your informat on whether or not the applicat on proceeds successfully.
18. You authorize the Bank to offset any outstanding amounts on your loan with Standard Chartered Bank Niger a Lim ted against your final entitlement in the event of exit/terminat on from employment for any
reason whatsoever.
19. You undertake to continue to domic le your salary with Standard Chartered Bank Niger a Lim ted (herein after called The Bank) for as long as the facil ty remains outstanding.
20. You agree that the Bank shall advise you of any notif cation of the change in interest rate/terms and condit ons will be deemed accepted unless the facil ty is paid down on or before the end of the notice period.
21. You agree that in the event of restructuring, a facil ty restructuring fee of 0.5% of the outstanding amount shall be charged.
22.You agree that the disbursement of the credit facil ty is subject to the approval of this applicat on form by the Bank and acceptance of the offer letter by you.
23. Your credit lim t assigned on the card will be at the sole discret on of the Bank and shall be inclus ve of the credit lim t of the supplementary Cardholder (if applicable). The credit lim t can be increased, decreased,
or blocked at the Bank's discret on. The lim t assigned is subject to any cash withdrawal and/or transaction lim t set by the Central Bank of Niger a from time to time.
24. Your card will be blocked (90) days after you have received it, if you have not activated it by then. In addit on, the cost of card will be passed to your Current/Savings account. You will be charged N1,000 (one-off)
as Issuance fees when your card is created. This cost is also applicable to renewal or replacement card.
25. The interest on your credit card will be charged per month on purchases not cleared with n your maximum 45-day interest free period and daily interest will accrue on cash withdrawals from the date of the
transaction until the date of full repayment.
26. Your credit card is not enabled for online (e-commerce) transactions by default, and you will be required to call Contact Center on +2342704611-4 or our toll-free number 08001235000 to enable your card.
27. Standing Instruction (SI) is automatically set up when your card was issued.
28. The min mum amount due is calculated as 1% of the total amount spent + 100% fees + 100% charges (subject to min mum payment requirements of N5,000).
29. Your card account will be closed if you have not in tiated any purchase or cash advance activ ty with n 24 months or if there is no outstanding princ pal balance (balance less than $50) on your card or there is no
fee charged or customer- in tiated payments with n 12 months.
30. Your card will be stopped from further transactions and charges of 1% late fees on due amount will apply in addit on to the interest charged if your repayment is late or missed.
31. You will get your statement fifteen days before your payment is due. When you get your statement, please make sure you pay in time for your payment to reach us on or before the due date.

For any queries and/or feedback you may get in touch with us on +23412704611-4 or our Toll-free number 08001235000 or Email: clientcare.ng@sc.com or vis t any of our branches.
Standard Chartered Bank is licensed and regulated by Central Bank of Niger a.

Applicant’s Name Signature Date:

DD MM YYYY

6 Authorisat on
This section must be signed in accordance with the signatory mandate held with Standard Chartered Bank.

Signatory Name: Signatory Name:

Signature: Signature:

Date: Date:
DD MM YYYY DD MM YYYY
SELF EMPLOYED CREDIT CARD APPLICATION FORM: Vs OCT 2023

7 For Bank Use

Insider Declaration

*Insider Relationsh ps: No Yes (If yes, provide details)

(*Insider relationsh p includes directors, staff, director’s wife, husband, father, mother, brother, sister, son, daughter and their spouses.)

Cardholder Relationsh p Number

RM Name Sales Code Sourcing ID

DD / MM / YYYY
Date supporting document was fully submitted Signature

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